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PEBP and Medicare
PLAN YEAR 2016 July 1, 2015 - June 30, 2016
Public
Employees’
Benefits
Program
901 South Stewart Street, Suite 1001
Carson City, NV 89701
mservices@peb.state.nv.us
www.pebp.state.nv.us
775-684-7000 or 800-326-5496
Twitter@NVPEBP
Introduction……………………………………………………………………………… 1
Medicare Parts A and B…..…………………………………………………………….. 2
Coverage Options for Medicare Retirees and Dependents………………………………. 3
Required Action………………………………………………………………………….. 4
Retiree Ages into Medicare AFTER Retirement………………………………………… 6
Retiree and/or Dependent with Medicare Due to SSA Disability……………………….. 7
Dependent of a Non-Medicare Retiree Ages-in to Medicare…………………………….
8
Employee Retires at Age 65 or Older……………………………………………………. 9
OneExchange - Health Reimbursement Arrangement (OneExchange-HRA)………….. 10
PEBP Dental Plan Option………………………………………………………………... 11
Unsubsidized Dependent Rates………………………………………………………….. 11
Contact Information……………………………………………………………………… 12
Table of Contents
06242015
Introduction Welcome to the State of Nevada Public Employees’ Benefits Program (PEBP). PEBP provides a
variety of benefits to eligible retirees and dependents such as medical, dental, life insurance, and
other voluntary insurance products.
Certain medical plan options and eligibility changes will occur for retirees and dependents entitled
to Medicare Parts A and B. This document will explain the various coverage options available to
Medicare beneficiaries, including, when to enroll in Medicare and other required actions that will
need to be completed by the retiree and/or dependent.
For additional information on the items listed below, visit www.pebp.state.nv.us.
PEBP Master Plan Document
NRS Chapter 287 and NAC Chapter 287
Towers Watson OneExchange website: http://www.pebp.state.nv.us/Medicare_Exchange.htm
Voluntary product offerings
Online access to your account information
Frequently asked questions and answers
Retiree enrollment guide
Newsletters
Public Employees’ Benefits Program (PEBP)
For questions regarding voluntary PEBP Dental coverage, eligibility or to request publications or
enrollment forms, please call 775-684-7000 or 800-326-5496 or email
mservices@peb.state.nv.us. Member Services staff is available 8:00 a.m. to 5:00 p.m. Pacific
time, Monday through Friday, except holidays. To ensure you receive accurate and courteous
service, telephone calls may be monitored.
Towers Watson OneExchange (formerly Extend Health)
For questions related to medical, dental, prescription drug, and vision plans offered through the
Medicare exchange, please call OneExchange at 888-598-7545, or visit:
www.extendhealth.com/pebp
Effective July 1, 2015
PEBP will allow eligible Medicare retirees with Tricare or Tricare for Life to receive a monthly
HRA allocation based on their years of service/retirement date without enrolling in a medical plan
through Towers Watson’s OneExchange.
This publication is provided for informational purposes only. Any discrepancies in the content
herein and Chapters 287 of the Nevada Revised Statutes (NRS) and the Nevada Administrative
Code (NAC), the Social Security Administration, Centers for Medicare and Medicaid Services
(CMS), and the PEBP Master Plan Document shall be superseded by PEBP’s official documents
and State and Federal law.
1
2
Medicare Parts A and B
PEBP requires retirees and dependents of retirees to enroll in premium-free Medicare Part A and
purchase Medicare Part B within the timeframes outlined in this guide.
To determine your eligibility for premium-free Medicare Part A, contact the Social Security
Administration approximately three months before your 65th birthday at 1-800-772-1213.
You Are Entitled to Premium-Free Medicare Part A and Part B
Submit a copy of your Medicare Part A and Part B card to the PEBP office.
You are Entitled to Tricare or Tricare for Life and Medicare Part A and Part B
Submit a copy of your Tricare or Tricare for Life identification card and Medicare Parts A and B
card to the PEBP office.
You Are Not Entitled to Premium-Free Medicare Part A
Submit a copy of the Part A denial letter issued by the Social Security Administration and a copy
of your Medicare Part B card to the PEBP office.
Timeframe for Submitting Required Medicare Document(s) to the PEBP Office
For birthdays occurring on the first day of the month, submit a copy of your Medicare Part A
(or your premium-free Medicare Part A denial letter) and Medicare Part B card no later than
the last day of the month in which you turn 65.
For birthdays NOT occurring on the first day of the month, submit a copy of your Medicare
Part A (or your premium-free Medicare Part A denial letter) and Medicare Part B card no
later than the last day of the month, following your 65th birthday month.
For retirees and covered dependents under age 65 who become eligible for Medicare due to
a disability, proof of Medicare Part A and B enrollment must be received within 60 days of
the Medicare Part A effective date.
For newly retiring employees, the Medicare Part A (or your premium-free Medicare Part A
denial letter) and Medicare Part B card within 60 days of your retirement coverage effective
date.
Retirees who are eligible to retain coverage under the PEBP CDHP or HMO plan receive a
Part B premium credit equal to the 2014 base cost of Medicare Part B coverage. The Part
B credit will not apply until the first of the month following PEBP’s receipt of the Part B
card or the effective date of Part B, whichever occurs later.
Failure to provide the required Medicare and Tricare (if applicable) verification will result
in termination of coverage, Basic Life Insurance, HRA contribution, and any voluntary
products.
3
Medicare Parts A and B
PEBP requires retirees and their covered dependents to enroll in premium-free Medicare Part A
and Part B by the last day of the 65th birthday month (for birthdays occurring between the second
day and the last day of the month) or no later than the last day of the month preceding the 65th
birthday (for birthdays occurring on the first day of the month). Note: Retiring employees aged
65 years or older are required to enroll in premium-free Part A and Part B to enroll in retiree
coverage.
Coverage Options for Medicare Retirees and Dependents Retirees and covered dependents with Medicare Parts A and B must enroll in a medical plan
through OneExchange. The following describes the coverage options based on the Medicare status
of a primary retiree and covered dependent (if any):
Retiree attains Medicare Parts A and B (no covered dependents)
Retiree must enroll in medical coverage through OneExchange to receive the
Exchange-Health Reimbursement Arrangement (Exchange-HRA), PEBP Dental coverage, and
Basic Life Insurance benefits (if applicable).
Retiree attains Medicare Parts A and B and has Tricare or Tricare for Life (no covered
dependents)
Retiree must submit a copy of the Parts A and B card and the Tricare or Tricare for Life card to
the PEBP office. Retiree may enroll in a medical plan through OneExchange; however, medical
coverage through OneExchange is not required to retain the monthly HRA funding.
Retiree attains Medicare Parts A and B and covers a dependent without Medicare.
Retiree may enroll in a medical plan through OneExchange and the non-Medicare dependent(s)
may stay on the CDHP or HMO plan as an unsubsidized dependent(s); or
Retiree may stay on the CDHP or HMO plan with the non-Medicare dependent(s) until spouse/
domestic partner enrolls in Medicare. In the case of a dependent child, the retiree may stay on a
PEBP plan until the child ceases to be an eligible dependent; or
Retiree may enroll in a medical plan through OneExchange and remove any covered
dependents from his or her plan.
Retiree is NOT entitled to Medicare covers a dependent with Medicare Parts A and B
Medicare dependent may enroll in a medical plan through OneExchange. The non-Medicare
retiree may stay on the CDHP or HMO coverage; or
Both the retiree and the Medicare dependent may remain on the CDHP or HMO coverage until
both become eligible for Medicare Parts A and B. In the case of a child, the retiree may retain
PEBP coverage until the child ceases to be an eligible dependent.
Retiree is Not Entitled to Premium-free Medicare Part A
Retiree may remain on the CDHP or HMO plan, but must purchase Medicare Part B.
4
Required Action
Retiree with Medicare Parts A and B (no covered dependents).
Retiree must enroll for medical coverage through OneExchange.
Submit a copy of the Medicare Parts A and B card to the PEBP office.
Contact OneExchange at 888-598-7545 to enroll in a medical, prescription drug,
vision and/or dental plan.
Complete the Retiree Benefit Enrollment and Change Form selecting Medicare Exchange with or
without PEBP Dental.
Submit the Retiree Benefit Enrollment and Change Form to the PEBP office.
Retiree with Medicare Parts A and B and Tricare or Tricare for Life (no covered dependents).
Retiree is not required to enroll in a medical plan through OneExchange, but must transition to
OneExchange to retain the monthly HRA funding.
Submit a copy of the Medicare Parts A and B card and Tricare card to the PEBP office.
Contact OneExchange at 888-598-7545.
Complete the Retiree Benefit Enrollment and Change Form.
Submit the Retiree Benefit Enrollment and Change Form to the PEBP office.
Retiree with Medicare Parts A and B and covers a dependent without Medicare.
If the retiree elects to enroll in medical coverage through OneExchange and retain coverage for the
non-Medicare dependent(s) on the CDHP or HMO plan, do the following:
Submit a copy of the Medicare Parts A and B card to the PEBP office.
Contact OneExchange at 888-598-7545 to enroll in a medical, prescription drug, vision and/or
dental plan.
Complete the Retiree Benefit Enrollment and Change Form selecting Medicare Exchange with or
without PEBP Dental.
If the retiree wishes to continue coverage for the non-Medicare dependent(s) on the CDHP or
HMO plan, contact PEBP at 775-684-7000 or 800-326-5496 to request the Benefit Enrollment and
Change Form for Unsubsidized Dependents. Note: Failure to submit this form to the PEBP office
will result in termination of coverage for all dependent(s).
Retiree without Medicare covers a dependent with Medicare Parts A and B
If the Medicare dependent wishes to enroll in a medical plan through OneExchange, do the
following:
Medicare dependent contacts OneExchange at 888-598-7545 to enroll in a medical, prescription
drug, vision and/or dental plan; and
If electing PEBP dental coverage, contact the PEBP office to request the Benefit Enrollment and
Change Form for Unsubsidized Dependents; or
If both the retiree and the Medicare dependent are staying on the CDHP or HMO coverage,
submit a copy of the dependent’s Medicare Parts A and B or if not eligible for Part A, a copy of
the Part B card to the PEBP office.
5
Required Action (continued)
Retiree is not entitled to premium-free Medicare Part A
Retiree may remain on the CDHP or HMO coverage with his or her dependent(s) if
applicable.
Retiree must purchase Medicare Part B; and
Obtain a Part A denial letter from the Social Security Administration; and
Submit copies of both documents to the PEBP office as follows:
For birthdays occurring on the first day of the month, the documents must be received
no later than the last day of the month the individual turns 65.
For birthdays NOT occurring on the first day of the month, submit the documents no
later than the last day of the month, following the 65th birthday month.
For newly retiring employees, submit the documents within 60 days of retirement
coverage effective date.
Active employee’s dependent ages-in to Medicare Parts A and B
If the Medicare dependent wishes to enroll in a medical plan through OneExchange, do the
following:
Medicare dependent contacts OneExchange at 888-598-7545 to enroll in a medical,
prescription drug, vision and/or dental plan; and
If electing PEBP dental coverage, contact the PEBP office to request the Benefit
Enrollment and Change Form for Unsubsidized Dependents; and
Employee completes the Benefit Enrollment and Change Form dropping the Medicare
dependent for his or her coverage.
6
Retiree Ages into Medicare AFTER Retirement
Birthday
Month
If your birthday
is on the first day
of the month see
below*
1
Medicare
Parts
A and B
3
You
complied
with 1 and 2
4
You did not
comply with
1 and 2
2
OneExchange
and PEBP
Enroll in
Medicare during
one of the following
months:
OneExchange
coverage
must start no
later than the
first day of
the following
month:
PEBP coverage
terms no later
than the last day
of this month:
Enroll in
OneExchange no
later than this month:
January Oct - Jan 31 Jan, Feb Jan 31 Jan 31
February Nov - Feb 28 Feb, Mar Feb 28 Feb 28
March Dec - Mar 31 Mar, Apr Mar 31 Mar 31
April Jan - Apr 30 Apr, May Apr 30 Apr 30
May Feb - May 31 May, Jun May 31 May 31
June Mar - Jun 30 Jun, Jul Jun 30 Jun 30
July Apr - Jul 31 Jul, Aug Jul 31 Jul 31
August May - Aug 31 Aug, Sept Aug 31 Aug 31
September Jun - Sep 30 Sept, Oct Sep 30 Sep 30
October Jul - Oct 31 Oct, Nov Oct 31 Oct 31
November Aug - Nov 30 Nov, Dec Nov 30 Nov 30
December Sep - Dec 31 Dec, Jan Dec 31 Dec 31
*For Medicare purposes, individuals attain age 65 the day before their actual 65th birthday and
Part A is effective on the first day of the month upon attainment of age 65.
*For individuals whose 65th birthday is on the first day of the month, Part A is effective on the
first day of the month preceding their birth month. For example, if an individual's birthday is
on December 1, Part A is effective on November 1, for Medicare purposes he or she attained
age 65 on November 30. For birthdays that occur on the first day of the month, use the
preceding month on the table to determine your enrollment period with Medicare and
OneExchange.
7
Retiree and/or Dependent with Medicare Due to SSA Disability
Medicare Effective
Date
Medicare becomes
effective on the 1st day
of the following month:
1
OneExchange
and PEBP
2
You complied with 1
3
You did not comply
with 1 and 2
Enroll in
OneExchange no
later than this
month:
OneExchange coverage must
start no later than the first day
of the following month:
PEBP coverage terms
no later than the last
day of this month
January Jan 31 Jan, Feb Jan 31
February Feb 28 Feb, Mar Feb 28
March Mar 31 Mar, Apr Mar 31
April Apr 30 Apr, May Apr 30
May May 31 May, Jun May 31
June Jun 30 Jun, Jul Jun 30
July Jul 31 Jul, Aug Jul 31
August Aug 31 Aug, Sept Aug 31
September Sep 30 Sept, Oct Sep 30
October Oct 31 Oct, Nov Oct 31
November Nov 30 Nov, Dec Nov 30
December Dec 31 Dec, Jan Dec 31
Retiree and/or dependent becomes eligible for Medicare Parts A and B due to receiving
benefits from the Social Security Administration.
The above individuals will be required to contact OneExchange to determine availability of
medical plan options and enrollment. However, if there is at least one individual covered on
the retiree’s coverage who does not have Medicare, this requirement may be waived for all
covered participants in the same coverage tier.
8
Dependent of a Non-Medicare Retiree Ages into Medicare
*For Medicare purposes, individuals attain age 65 the day before their actual 65th birthday and
Part A is effective on the first day of the month upon attainment of age 65.
*For individuals whose 65th birthday is on the first day of the month, Part A is effective on the
first day of the month preceding their birth month. For example, if an individual's birthday is
on December 1, Part A is effective on November 1, for Medicare purposes he or she attained
age 65 on November 30. For birthdays that occur on the first day of the month, use the
preceding month on the table to determine your enrollment period with Medicare and
OneExchange.
Birthday
Month
If your birthday is
on the first day of
the month see
below*
1
Medicare
Parts
A and B
3
You complied
with 1 and 2
4
You did not
comply with
1 and 2
2
OneExchange
and PEBP
Enroll in
Medicare during
one of the following
months:
OneExchange
coverage must start
no later than the first
day of the following
month:
You cannot
enroll through
OneExchange
until the retiree
ages-in or Open
Enrollment
Enroll in
OneExchange
no later than
this month:
January Oct - Jan 31 Jan, Feb - Jan 31
February Nov - Feb 28 Feb, Mar - Feb 28
March Dec - Mar 31 Mar, Apr - Mar 31
April Jan - Apr 30 Apr, May - Apr 30
May Feb - May 31 May, Jun - May 31
June Mar - Jun 30 Jun, Jul - Jun 30
July Apr - Jul 31 Jul, Aug - Jul 31
August May - Aug 31 Aug, Sept - Aug 31
September Jun - Sep 30 Sept, Oct - Sep 30
October Jul - Oct 31 Oct, Nov - Oct 31
November Aug - Nov 30 Nov, Dec - Nov 30
December Sep - Dec 31 Dec, Jan - Dec 31
9
Employee Retires at Age 65 or Older
Month of
retirement
1
Medicare
Parts
A and B
3
You complied
with 1 and 2
4
You did not
comply with
1 and 2
2
OneExchange
and PEBP
Enroll in
Medicare prior to or
during
one of these
months:
OneExchange
coverage must
start no later than
the first day of
the following:
PEBP coverage
terms no later
than the last day
of the following:
Enroll in
OneExchange no
later than the
following:
January Oct - Mar Feb, Mar or Apr Jan, Feb or Mar Mar 31
February Nov - Apr Mar , Apr or
May Feb, Mar or Apr Apr 30
March Dec - May Apr, May or Jun Mar, Apr or May May 31
April Jan - Jun May, Jun or Jul Apr, May or Jun Jun 30
May Feb - Jul Jun, Jul or Aug May, Jun or Jul Jul 31
June Mar - Aug Jul, Aug or Sept Jun, Jul or Aug Aug 31
July Apr - Sept Aug, Sept or Oct Jul, Aug or Sept Sept 30
August May - Oct Sept, Oct or Nov Aug, Sept or Oct Oct 31
September Jun - Nov Oct, Nov or Dec Sept, Oct or Nov Nov 30
October Jul - Dec Nov, Dec or Jan Oct, Nov or Dec Dec 31
November Aug - Jan Dec, Jan or Feb Nov, Dec or Jan Jan 31
December Sep - Feb Jan 1, Feb or
Mar Dec, Jan or Feb Feb 28
Generally, the effective date of your retirement is the first day of the month following the
month you terminate employment.
Example: Employee terminates employment November 14 and retires November 15. The
effective date of retiree health insurance coverage is December 1. In this example, the Medi-
care retiree must enroll in medical coverage through OneExchange by January 31 for cover-
age to begin February 1. Failure to enroll as indicated on the table above will result in termi-
nation of coverage.
10
OneExchange - Health Reimbursement Arrangement
(OneExchange-HRA)
Retirees enrolled in a medical plan through OneExchange receive a monthly years of service
contribution to an Exchange Health Reimbursement Arrangement (OneExchange-HRA).
The monthly tax-exempt contribution is $11 per month, per year of service, beginning with
five years ($55) to a maximum of twenty years of service ($220). Individuals who retired
before January 1, 1994, receive a flat $165 per month. Note: Employees hired after January
1, 2010, who retire with fewer than 15 years of service do not qualify for the OneExchange-
HRA contribution.
Retirees with an employment hiring date on or after January 1, 2012, dependents and survi-
vors do NOT qualify for the One-Exchange HRA.
The OneExchange-HRA funds may be used for reimbursement of qualified health, dental,
and pharmacy expenses, Medicare Part B premiums and qualifying out-of-pocket health care
expenses for both retirees and their dependents as defined by IRS Publication 502 available
at www.irs.gov.
Retiring employees aged 65 or older will receive HRA funding concurrent with the medical
plan effective date through OneExchange.
I M P O R T A N T !
Eligible retirees who enroll in and maintain coverage in a medical plan through
OneExchange receive a Years of Service OneExchange-HRA contribution based upon the
retirement date and years of service (earned service credit only). Contributions commence
concurrent with the effective date of the medical coverage through OneExchange.
HRA Contribution Eligibility (NRS 287.046 (6) (a) (b): To receive the PEBP HRA contri-
bution, an eligible retiree must enroll in and maintain an individual medical insurance policy
through the PEBP sponsored Towers Watson OneExchange. If the eligible retiree does not
enroll and maintain medical coverage as described above, the eligible retiree will NOT re-
ceive the HRA contribution amount and will lose their PEBP sponsored benefits entirely.
This policy also applies to eligible retirees who have health coverage under TRICARE or
under a policy or plan provided by his or her spouse’s or domestic partner’s employer.
Please note that during the Medicare Open Enrollment Period which is held each year from
October 15 through December 7, you may be inundated with mailings and solicitations from
other insurance companies and brokers that offer the same medical plans as OneExchange.
However, these companies and individuals are not associated with PEBP or OneExchange,
and changing your medical plan outside of OneExchange will terminate your association
with PEBP. To ensure you continue receiving these benefits, you must continue your current
medical coverage or select a different medical plan through OneExchange (you must be en-
rolled in a medical plan through OneExchange to remain eligible for HRA and life insur-
ance benefits).
11
PEBP Dental Plan Option
Retirees and covered spouses/domestic partners enrolled in a medical plan through
OneExchange who want to elect the PEBP Dental Plan must complete the Retiree Benefit
Enrollment and Change Form (or Benefit Enrollment and Change Form for Unsubsidized
Dependents) and select Exchange with PEBP Dental. The completed form must be received
in the PEBP office on or before the medical plan effective date through OneExchange.
By electing the PEBP Dental Plan you will be required to maintain dental coverage through-
out the Plan year unless you terminate your medical plan through OneExchange. Changes to
the PEBP Dental Plan may be completed during PEBP’s annual open enrollment period.
Unsubsidized Rates
State Retiree Dependents PPO Plan HMO
Child or Spouse/Domestic Partner 580.78 730.30
Children 765.62 1,052.65
Spouse/DP + Child(ren) 765.62 1,052.65
Unsubsidized Rates
Non-State Retiree Dependents
PPO Plan HMO
Child or Spouse/Domestic Partner 957.06 777.70
Children 1,700.53 1,152.52
Spouse/DP + Child(ren) 1,700.53 1,152.52
Voluntary Dental Coverage Option for Medicare Retirees Optional dental coverage for participants enrolled in an OneExchange Medical Plan
Voluntary Dental Coverage State Retiree Rate Non-State Retiree Rate
Retiree only 35.34 35.75
Retiree + Spouse/DP 70.67 71.51
Surviving/Unsubsidized Spouse/DP 35.34 35.75
To enroll in PEBP dental coverage, select Exchange with PEBP dental when
completing your enrollment form. Note: Retirees paid through PERS will pay their
monthly premium through PERS deductions.
Unsubsidized Dependent Rates
12
Contact Information
Public Employees’ Benefits Program 901 South Stewart Street, Suite 1001
775-684-7000 or 800-326-5496
www.pebp.state.nv.us
mservices@peb.state.nv.us
Towers Watson OneExchange 888-598-7545
www.ExtendHealth.com/PEBP
Social Security Administration 800-772-1213
www.ssa.gov
Centers for Medicare and Medicaid Services 800-633-4227
www.cms.gov
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